The MAP for Care Act directs the Secretary of Health and Human Services to build an Advance Directive Certification Program that encourages Medicare beneficiaries to adopt electronically stored, state‑law‑recognized advance directives offered by accredited vendors. The bill makes participation voluntary, requires CMS to publish statutory and alternative state forms, and directs outreach to beneficiaries through existing Medicare communications.
Why it matters: the measure moves advance directives from paper files and siloed registries toward an interoperable, CMS‑linked model with baseline privacy, security, and quality controls. That creates new obligations for vendors and new accessibility expectations for providers while raising questions about federal‑state interaction, data protection, and who pays for implementation and integration.
At a Glance
What It Does
The bill requires the Secretary to establish an Advance Directive Certification Program and to accredit vendors who furnish electronically stored advance directives that comply with State law. CMS must host links to state statutory forms and accepted alternative forms, and vendors must meet privacy, security, testing, and access criteria to be listed.
Who It Affects
Directly affected parties include Medicare beneficiaries, advance‑directive vendors and registries, health IT/EHR integrators, hospitals and clinicians who must retrieve directives in real time, and state officials responsible for advance‑directive law and enforcement. CMS operations and oversight resources are also implicated.
Why It Matters
This creates a de facto national infrastructure for storing and verifying advance directives: it normalizes electronic directives, sets certification and interoperability expectations, and introduces oversight tools (quality reviews and delisting) that could change how clinicians locate and follow patient wishes in acute settings.
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What This Bill Actually Does
The MAP for Care Act builds a voluntary federal program that makes it easier for Medicare enrollees to create, register, and share advance directives that comply with the law of their State. It defines a “certified advance directive” as an electronically stored, written instruction (for example, a living will or durable power of attorney for health care) offered through an entity accredited under the new program.
The Secretary must set up the program and make resources available for beneficiaries to find and adopt state‑specific forms on a CMS website.
Enrollment procedures are intended to be user‑driven: beneficiaries who join must indicate where their directive is maintained or how to access it, and they can update, amend, or terminate their directive at will. The bill ties beneficiary outreach to existing Medicare communications—CMS must notify eligible beneficiaries during the annual coordinated election period and include links on enrollment applications after the program starts.Accreditation is the operational core.
The Secretary (or a contracted accreditation organization) sets criteria that vendors must meet: online enrollment and timely updates, near real‑time access to directives, compliance with Federal privacy rules derived from HIPAA, documented security testing and real‑time load testing, annual quality reviews, and beneficiary surveys. CMS may remove a vendor’s directives from its website if a vendor fails the annual review.The bill also addresses practical interoperability and dispute scenarios.
Vendors must use nationally recognized standards for secure data transfer so beneficiaries, legally designated proxies, providers, and specified family members can view and share directives. In cases where a participant becomes incapacitated and there is a conflict over treatment, the vendor must have a process to grant access to certain “interested individuals” even if they are not the primary designee.Finally, CMS will post two categories of forms: state statutory forms and “alternative” forms submitted by outside groups.
Alternative forms must be accompanied by a lawyer’s opinion that they comply with state law; CMS must post or explain rejections within 60 days, and state attorneys general or court rulings can trigger removal or refusal to post.
The Five Things You Need to Know
The bill defines a “certified advance directive” as an electronically stored, state‑law recognized written instruction (e.g.
living will or durable power of attorney for health care) offered only by an accredited vendor.
The Secretary must establish vendor accreditation criteria that include online enrollment/registration, near real‑time access, annual quality reviews, independent security testing, and vendor certification that systems can handle realistic simultaneous access.
CMS must publish both statutory state advance‑directive forms and ‘alternative’ forms submitted by groups; alternative forms require a state‑licensed attorney’s opinion and CMS must respond to submissions within 60 days.
Program enrollment is voluntary and revocable: beneficiaries may register or terminate a certified advance directive at any time, and vendors must allow timely creation, modification, and termination.
Vendors must run an annual beneficiary survey reporting whether participants paid third parties for services, whether directives were accessible in an emergency, whether directives were clear and actionable, and whether medical personnel followed them.
Section-by-Section Breakdown
Every bill we cover gets an analysis of its key sections.
Short title
Provides the Act’s formal name: the Medicare Advance Planning for Care Act, or MAP for Care Act. This is purely stylistic but important for citation and cross‑referencing in regulations and guidance.
Creates the Advance Directive Certification Program and defines key terms
This subsection directs the Secretary to set up the Program (with a five‑year maximum implementation window) and defines ‘certified advance directive,’ ‘eligible beneficiary,’ and ‘Program participant.’ Practically, the definition ties certification to electronic storage and to recognition under State law, ensuring that any certified directive must simultaneously meet federal certification rules and state legal requirements governing content and effect.
Enrollment mechanics, beneficiary notice, and HIPAA‑based privacy baseline
This part requires beneficiaries to state where their directive is maintained when they register and obliges CMS to notify eligible beneficiaries during the annual coordinated election period. It mandates that enrollment and registry systems comply with HIPAA privacy and security regulations and limits access to the participant, authorized proxies/family members, and treating providers—while leaving the Secretary to define the exact access processes.
Vendor accreditation standards, quality reviews, and CMS enforcement
The Secretary (or a contractor) must accredit vendors against a detailed list of operational criteria: enrollment workflows, online registration, near real‑time access using nationally recognized data standards, hard‑copy provision on request, annual quality reviews, beneficiary surveys, rigorous independent security testing, and scalability testing. Noncompliant vendors may be delisted by CMS, which creates an administrative enforcement lever short of civil penalties but with market consequences.
Procedures to grant access in treatment disputes
This targeted provision compels vendors to implement a special access channel when a directive has become operative (for example, after incapacity) and at least one person is contesting treatment decisions. It defines who qualifies as an ‘interested individual’ and requires vendors to prompt beneficiaries to periodically update named individuals if the State’s default ordering doesn’t apply—introducing an administrative path for contested access that intersects with state substitute‑decision‑maker rules.
CMS website posting of state statutory and alternative forms and beneficiary outreach
CMS must host a user‑friendly, State‑indexed collection of statutory forms and alternative forms (the latter accompanied by an attorney opinion of state‑law compliance). Alternative submissions receive a decision within 60 days and can be removed if a State AG or controlling court rules them noncompliant. The Secretary must also include information about the Program in standard Medicare notices and place links on enrollment applications after implementation.
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Explore Healthcare in Codify Search →Who Benefits and Who Bears the Cost
Every bill creates winners and losers. Here's who stands to gain and who bears the cost.
Who Benefits
- Medicare beneficiaries—especially those with chronic conditions or high hospitalization risk—gain easier, faster access to state‑law compliant, electronically verifiable advance directives, improving the odds that providers can locate and follow their wishes in emergencies.
- Clinicians and hospitals receive clearer, centralized access paths to patient directives, which can reduce delays, administrative friction, and conflicts over treatment when directives are available in near real time through certified systems.
- Advance‑directive vendors, health IT firms, and EHR integrators can capture new markets by becoming accredited providers, supplying secure storage, interoperability connectors, and integration services to hospitals and health systems.
- Family caregivers and legally designated proxies benefit from standardized mechanisms to access and share directives, lowering the transaction cost of proving a patient’s wishes during crises.
- State courts and attorneys advising clients on estate and health planning gain a searchable repository of state statutory forms and vetted alternative forms, which can streamline compliance assessments.
Who Bears the Cost
- Advance‑directive vendors and small registries must invest in security certification, independent testing, scalability testing, privacy compliance, and annual quality processes to obtain and maintain accreditation.
- CMS and HHS must allocate substantial staff and contracting resources to build the registry index, run accreditation or manage contractors, administer quality reviews, and handle removal decisions and outreach—an unfunded or underfunded administrative burden.
- Hospitals and clinicians may face integration costs to enable near real‑time retrieval of directives into clinical workflows and EHRs, and training costs to ensure staff locate and honor certified directives.
- States and state attorneys general may see increased legal work and resource demands when policing compliance of alternative forms or when disputes rely on federally hosted documents and access protocols.
- Low‑income or digitally underserved beneficiaries may indirectly bear costs if vendors charge fees for creation, storage, or retrieval; the bill requires vendors to report whether beneficiaries paid third parties, but it does not prohibit fees.
Key Issues
The Core Tension
The central tension is between two legitimate goals that pull in opposite directions: make advance directives widely accessible, verifiable, and actionable (which pushes toward standardized federal certification, interoperability, and broader access), versus protect individual privacy and respect the primacy of State law and individualized legal formalities (which pushes toward narrower access, state‑specific procedures, and decentralized control). The bill tries to achieve both, but doing so shifts important decisions to CMS design choices with real consequences for privacy, cost, and state–federal balance.
The bill attempts to thread a narrow needle: it preserves State law as the substantive source of validity for advance directives but builds a federal certification and hosting structure that will likely become the operational standard for locating directives. That arrangement raises practical preemption tensions—if vendors design systems around CMS accreditation requirements and national standards, they may effectively prioritize forms and features that are easiest to certify, even where State law has different formalities.
Privacy and access rules are another knotty area. The bill anchors privacy to HIPAA but simultaneously expands access pathways (near real‑time access; special access during disputes; sharing with family and proxies).
Those access windows are sensible for clinical use but expand the number of parties who can obtain sensitive end‑of‑life wishes; the bill gives vendors discretion to design workflows and the Secretary latitude to define standards, leaving open questions about audit trails, consent revocation, and remedies for unauthorized access. The ‘special access’ process during disputes, in particular, creates a mechanism to override typical access hierarchies in the name of resolving disagreement—useful for conflict resolution but also a vector for contested privacy intrusions.
Operationally, the accreditation and testing expectations are ambitious: independent security testing, realtime load simulations, beneficiary surveys, and annual quality reviews are costly. The statute says CMS may contract for accreditation, but it does not fund implementation or authorize specific appropriations for vendor oversight, nor does it clarify who covers the cost when integration is needed in clinical IT systems.
Finally, some key terms—“near real‑time,” “nationally recognized standards,” and the thresholds for delisting—are delegated to the Secretary’s rulemaking, meaning practical outcomes will depend heavily on administrative choices and contracting decisions.
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